CD8 alveolitis in sarcoidosis: Incidence, phenotypic characteristics, and clinical features

Agostini, Carlo; Trentin, Livio; Zambello, Renato; Bulian, Pietro; Siviero, Fosca; Masciarelli, M; Festi, Giuliana; Cipriani, A; Semenzato, Gianpietro

doi:10.1016/0002-9343(93)90328-m

Cited by 49 publications

(25 citation statements)

References 10 publications

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“…Early reports of BAL and lung biopsy findings from patients with sarcoidosis suggested that the influx of CD4+ lymphocytes typically seen early in the alveolitis may be replaced by CD8+ lymphocytes as the disease stabilizes or becomes inactive [4,43]. Subsequent reports have not demonstrated an association of the CD4/CD8 ratio with duration of symptoms or radiographic stage [20,44]. Our findings suggest that a low CD4/CD8 ratio on BAL lymphocyte subset analysis should not be used to exclude the diagnosis of sarcoidosis.…”

Section: Discussionmentioning

confidence: 64%

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The CD4/CD8 ratio in BAL fluid is highly variable in sarcoidosis

Kantrow¹,

Meyer²,

Kidd³

et al. 1997

Eur Respir J

131

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T Th he e C CD D4 4/ /C CD D8 8 r ra at ti io o iin n B BA AL L f fl lu ui id d i is s h hi ig gh hl ly y v va ar ri ia ab bl le e i in n s sa ar rc co oi id do os si is s S.P. Kantrow*, K.C. Meyer**, P. Kidd*, G. Raghu* The CD4/CD8 ratio in BAL fluid is highly variable in sarcoidosis. S.P. Kantrow, K.C. Meyer, P. Kidd, G. Raghu. ERS Journals Ltd 1997. ABSTRACT: Patients with pulmonary sarcoidosis frequently have increased numbers of lymphocytes and a high ratio of CD4+ to CD8+ T-lymphocytes (CD4/CD8 ratio) in bronchoalveolar lavage (BAL) fluid. Some investigators have suggested that these parameters can be used to distinguish sarcoidosis from other types of interstitial lung disease with a high degree of reliability. However, we hypothesized that the BAL CD4/CD8 ratio measured during the initial diagnostic evaluation of patients with biopsy-proven sarcoidosis is highly variable.BAL lymphocytes were analysed via flow cytometry to determine the CD4/CD8 ratio in a population of 86 patients with histological and clinical evidence of sarcoidosis, who underwent BAL as part of their initial diagnostic evaluation.In these patients, the CD4/CD8 ratio ranged 0.5-37.3, with a median value of 3.35 (mean 6.49). The CD4/CD8 ratio was greater than 4 in only 36 (42%) subjects. Ten patients (12%) had a CD4/CD8 ratio less than 1. The distribution of CD4/CD8 ratios was similar in the presence or absence of BAL lymphocytosis.In conclusion, the CD4/CD8 ratio in bronchoalveolar lavage fluid is highly variable in biopsy-proven sarcoidosis. Bronchoalveolar lavage lymphocyte subset determination is a diagnostic test with low sensitivity for this disease.

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Section: Discussionmentioning

confidence: 64%

“…AGOSTINI et al [20] recently reported that 3.8% of sarcoid patients in their series had a BAL fluid CD4/CD8 ratio <1. They suggested that the clinical course does not differ substantially from that of patients with CD4+ T-lymphocyte predominant alveolitis.…”

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confidence: 86%

The CD4/CD8 ratio in BAL fluid is highly variable in sarcoidosis

Kantrow¹,

Meyer²,

Kidd³

et al. 1997

Eur Respir J

131

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“…Velcro crackles, uncommon in pulmonary sarcoidosis, were noted in half of our CVID/GD patients. BAL was available in 14 of our patients; even though lymphocytosis was found in most cases, as in sarcoidosis, a decreased CD4/CD8 T-cell ratio, which is very rare in sarcoidosis [16], was found in 50% of cases, while only one patient had a ratio .3.5, a manifestation commonly found in sarcoidosis and considered as highly suggestive of this diagnosis [17].…”

Section: Discussionmentioning

confidence: 84%

Granulomatosis-associated common variable immunodeficiency disorder: a case-control study versus sarcoidosis

Bouvry¹,

Mouthon²,

Brillet³

et al. 2012

European Respiratory Journal

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The aim of the present study was to investigate to what extent interstitial lung disease (ILD) in common variable immunodeficiency disorder (CVID)-associated granulomatous disease (GD) is similar to pulmonary sarcoidosis 20 patients with CVID/GD were included in a retrospective study conducted by the Groupe Sarcoïdose Francophone. Medical records were centralised. Patients were compared with 60 controls with sarcoidosis.Clinical examination showed more frequent crackles in patients than controls (45% versus 1.7%, respectively; p,0.001). On thoracic computed tomography scans, nodules (often multiple and with smooth margins), air bronchograms and halo signs were more frequent in patients than controls (80% versus 42%, respectively; p50.004) as well as bronchiectasis (65% versus 23%, respectively; p,0.001). The micronodule distribution was perilymphatic in 100% of controls and in 42% of patients (p,0.001). Bronchoalveolar lavage analysis showed lower T-cell CD4/CD8 ratios in patients than in controls (mean¡SD 1.6¡1.1 versus 5.3¡4, respectively; p,0.01). On pathological analysis, nodules and consolidations corresponded to granulomatous lesions with or without lymphocytic disorders in most cases. Mortality was higher in patients than controls (30% versus 0%, respectively) and resulted from common variable immunodeficiency complications.ILD in CVID/GD presents a specific clinical picture and evolution that are markedly different from those of sarcoidosis.

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“…However, cases with a high CD 4+ /CD 8+ ratio, similar to our patient, have been described [6, 7]. In sarcoidosis, BAL is lymphocytic with a high CD 4+ /CD 8+ ratio [5], but it was recognized recently that it could be variable in newly diagnosed sarcoidosis patients [8, 9]. In EAA, another diagnostic possibility in our patient, BAL CD 4+ /CD 8+ ratio is typically low that it recovers on chronic exposure [10].…”

Section: Discussionmentioning

confidence: 90%

Miliary Sarcoidosis following Miliary Tuberculosis

Hatzakis

Siafakas²,

Bouros³

2000

Respiration

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A patient who presented with a miliary radiographic pattern due to tuberculosis and later with a similar miliary pattern due to sarcoidosis is described. The patient, a 47-year-old man, was admitted to the hospital due to coughing, weakness, weight loss and an abnormal chest radiograph with a miliary pattern. A gastric fluid culture was positive for Mycobacterium tuberculosis and he was treated appropriately. He showed complete clinical and radiological remission. One year later he presented with a dry cough and a similar miliary pattern on the chest roentgenogram. Lung biopsy taken by thoracoscopy revealed sarcoidosis. The patient had a complete remission with corticosteroids. To our knowledge, this is the first report describing a miliary pattern as presenting radiological sign in a patient with tuberculosis who subsequently developed a new miliary pattern due to sarcoidosis.

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CD8 alveolitis in sarcoidosis: Incidence, phenotypic characteristics, and clinical features

Cited by 49 publications

References 10 publications

The CD4/CD8 ratio in BAL fluid is highly variable in sarcoidosis

The CD4/CD8 ratio in BAL fluid is highly variable in sarcoidosis

Granulomatosis-associated common variable immunodeficiency disorder: a case-control study versus sarcoidosis

Miliary Sarcoidosis following Miliary Tuberculosis

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